Noroviruses as a Cause of Traveler's Diarrhea among Students from the United States Visiting Mexico

Ko, Gwang Pyo; García, Coralith; Jiang, Zhi; Okhuysen, Pablo C.; Belkind‐Gerson, Jaime; Glass, Roger I.; DuPont, Herbert L.

doi:10.1128/jcm.43.12.6126-6129.2005

Cited by 67 publications

(54 citation statements)

References 24 publications

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“…Travelers who acquired diarrhea in Mexico in 2007 had more NoV GI than GII strains identified, although there were relatively few NoV diarrhea cases in Mexico during this time period. Similarly, in a previous surveillance study performed by our group in Mexico during the summer of 2004, 81% of NoVs detected were NoV GI strains (16). In the present study, 66.7% and 83.3% of NoVs identified in travelers to Mexico in 2002 to 2003 and 2006, respectively, were GII strains.…”

Section: Discussionsupporting

confidence: 52%

“…The two reports demonstrated significant but variable prevalence rates of NoV diarrhea of 17% and 65% in persons visiting Mexico or Mexico and Guatemala, respectively. Interestingly, both studies identified GI NoVs as the genogroup most frequently detected (7,16). The present study was designed to compare patterns of prevalence of NoV infection in international travelers with diarrhea acquired in Mexico over several time periods and in different developing regions of the world, including Mexico, Guatemala, and India, and to characterize the symptoms associated with NoV diarrhea.…”

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confidence: 99%

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Noroviruses as a Cause of Diarrhea in Travelers to Guatemala, India, and Mexico

et al. 2010

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Noroviruses (NoVs) are increasingly being recognized as an important enteric pathogen of gastroenteritis worldwide. The prevalence of NoVs as a cause of diarrhea acquired by travelers in developing countries is not well known. We examined the prevalence and importance of NoV infection in three international traveler cohorts with diarrhea acquired in three developing regions of the world, Mexico, Guatemala, and India. We also characterized the demographics and symptoms associated with NoV diarrhea in these travelers. Stool samples from 571 international travelers with diarrhea were evaluated for traditional enteropathogens. NoVs were identified using reverse transcription-PCR and probe hybridization. NoVs were identified in 10.2% of cases of travelers' diarrhea and, overall, was the second most common pathogen, following diarrheagenic Escherichia coli. The detection of NoV diarrhea significantly varied over the three study time periods in Guadalajara, Mexico, ranging from 3 of 98 (3.0%) diarrheal stools to 12 of 100 (12.0%) fecal specimens (P ‫؍‬

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Section: Discussionsupporting

confidence: 52%

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confidence: 99%

Noroviruses as a Cause of Diarrhea in Travelers to Guatemala, India, and Mexico

et al. 2010

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“…Ko et al [47] found evidence of norovirus gastroenteritis in 21 out of 124 (17%) US travelers to Mexico. If one considers that up to 40% of traveler's diarrhea is not bacterial or protozoal and that 20% of traveler's symptoms do not respond to antibiotic prophylaxis, this may be the range of frequency of norovirus as a cause of traveler's diarrhea.…”

Section: Travel To Developing Countriesmentioning

confidence: 98%

Norovirus gastroenteritis

Goodgame

2007

Curr Infect Dis Rep

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Recent epidemiologic studies have shown that norovirus is one of the most frequent causes of acute nonbacterial gastroenteritis. Reverse-transcription polymerase chain reaction and nucleotide sequencing are the means by which the hundreds of norovirus strains have been identified, named, and classified into genogroups and genetic clusters. They are also the means by which a particular strain is traced from the source of an outbreak throughout its spread. These molecular techniques have been combined with classic epidemiology to investigate norovirus outbreaks in diverse settings, including hospitals, nursing homes, dining locations, schools, daycare centers, and vacation venues. Outbreaks are difficult to control because of the apparent ease of transmission through food, water, person-to-person contact, and environmental surfaces. Almost all patients with norovirus gastroenteritis recover completely, but hospital and nursing home outbreaks have been associated with morbidity and mortality. The diagnostic and management approach to an individual patient is to use clinical and epidemiologic findings to rule out "not norovirus." At the first sign that there is an outbreak, strict compliance with cleaning, disinfection, and work release guidelines is important to prevent further spread.

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“…ETEC isolates from travelers can produce heat-labile toxin (LT), heat-stable toxin (ST), or both toxins simultaneously (LT/ST). Approximately 43% to 68% of strains isolated from subjects with TD in Mexico produce LT alone or in combination with ST (1,11,13). Contact with ETEC LT, as a result of vaccination or after natural infection, is associated with the production of LTspecific antibodies (8, 15) and may serve as an indicator of ETEC LT exposure.…”

Section: Up To 60% Of Us Visitors To Mexico Develop Traveler's Diarmentioning

confidence: 99%

Influence of Host Interleukin-10 Polymorphisms on Development of Traveler's Diarrhea Due to Heat-Labile Enterotoxin-ProducingEscherichia coliin Travelers from the United States Who Are Visiting Mexico

Flores

DuPont

Lee

et al. 2008

Clin Vaccine Immunol

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Up to 60% of U.S. visitors to Mexico develop traveler's diarrhea (TD), mostly due to enterotoxigenicEscherichia coli (ETEC) strains that produce heat-labile (LT) and/or heat-stable (ST) enterotoxins. Distinct single-nucleotide polymorphisms (SNPs) within the interleukin-10 (IL-10) promoter have been associated with high, intermediate, or low production of IL-10. We conducted a prospective study to investigate the association of SNPs in the IL-10 promoter and the occurrence of TD in ETEC LT-exposed travelers. Sera from U.S. travelers to Mexico collected on arrival and departure were studied for ETEC LT seroconversion by using cholera toxin as the antigen. Pyrosequencing was performed to genotype IL-10 SNPs. Stools from subjects who developed diarrhea were also studied for other enteropathogens. One hundred twenty-one of 569 (21.3%) travelers seroconverted to ETEC LT, and among them 75 (62%) developed diarrhea. Symptomatic seroconversion was more commonly seen in subjects who carried a genotype producing high levels of IL-10; it was seen in 83% of subjects with the GG genotype versus 54% of subjects with the AA genotype at IL-10 gene position ؊1082 (P, 0.02), in 71% of those with the CC genotype versus 33% of those with the TT genotype at position ؊819 (P, 0.005), and in 71% of those with the CC genotype versus 38% of those with the AA genotype at position ؊592 (P, 0.02). Travelers with the GCC haplotype were more likely to have symptomatic seroconversion than those with the ATA haplotype (71% versus 38%; P, 0.002). Travelers genetically predisposed to produce high levels of IL-10 were more likely to experience symptomatic ETEC TD.Traveler's diarrhea (TD) affects up to 60% of short-term U.S. visitors to developing countries (23). Although TD is a self-limited disease with few acute complications, it can result in significant transient discomfort, cause changes in travel plans, and produce temporary incapacitation (25). TD has also been associated with long-term complications, such as postinfectious reactive arthritis, (27) Guillain-Barré neuropathy (22), and postinfectious irritable bowel syndrome (17).Up to 85% of TD cases are bacterial in origin. In Mexico, enterotoxigenic Escherichia coli (ETEC) is the single mostcommonly identified agent in the stools of travelers with diarrhea, ranging from 19% to 40% of cases (3). ETEC isolates from travelers can produce heat-labile toxin (LT), heat-stable toxin (ST), or both toxins simultaneously (LT/ST). Approximately 43% to 68% of strains isolated from subjects with TD in Mexico produce LT alone or in combination with ST (1,11,13). Contact with ETEC LT, as a result of vaccination or after natural infection, is associated with the production of LTspecific antibodies (8, 15) and may serve as an indicator of ETEC LT exposure.Previous studies carried out in Bangladesh have demonstrated that after adjusting for confounding variables, such as age and prior exposure, ETEC LT can be identified with similar frequencies in the stools of children with diarrhea and healthy controls (...

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Noroviruses as a Cause of Traveler's Diarrhea among Students from the United States Visiting Mexico

Cited by 67 publications

References 24 publications

Noroviruses as a Cause of Diarrhea in Travelers to Guatemala, India, and Mexico

Noroviruses as a Cause of Diarrhea in Travelers to Guatemala, India, and Mexico

Norovirus gastroenteritis

Influence of Host Interleukin-10 Polymorphisms on Development of Traveler's Diarrhea Due to Heat-Labile Enterotoxin-ProducingEscherichia coliin Travelers from the United States Who Are Visiting Mexico

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